Artículos (Medicina)

URI permanente para esta colecciónhttps://hdl.handle.net/11441/11045

Examinar

Mostrando 1 - 20 de 1410

Systematic evaluation of subgroup analyses of inhaled treprostinil in pulmonary hypertension due to interstitial lung disease
(Public Library of Science (PLoS), 2025-02-12) Martínez Puig, Pablo; Báez Gutiérrez, Nerea; Rodríguez Ramallo, Héctor; Abdel-Kader Martín, Laila; Otero Candelera, Remedios; Farmacia y Tecnología Farmacéutica; Medicina
Background The INCREASE trial introduced a novel therapeutic option for Pulmonary Hypertension caused by Interstitial Lung Disease. Subsequently to this trial, several subgroup analyses were conducted, aiming to explore specific effects within subgroups. Objective This study aimed to evaluate the subgroup analyses performed in the INCREASE trial and to identify potentially reliable subgroup effects. Methods A methodological assessment of the subgroup analyses was performed. Claims of subgroup effect were evaluated using three different tools: Sun, X et al. 2012, Gil-Sierra, M.D et al2020, and Schandelmaier, S et al. 2020. Additionally, all statistically significant subgroup effects that were not claimed by the authors were evaluated. Results Five claims of subgroup effect were identified; none of them achieved statistical significance when assessed using an interaction test. The evaluation conducted with the three tools consistently yielded very low credibility for all the claims. During the assessment, a statistically significant subgroup effect of moderate credibility was identified, which the authors did not claim: iTre appeared to improve exercise capacity exclusively in patients with Pulmonary Vascular Resistance ⋝ 4 WUs. Conclusions Due to methodological limitations, the credibility of subgroup claims from the authors of the INCREASE was lacking and, therefore, should not be relied upon to inform decisions on an individual basis.
Machine learning approaches to enhance diagnosis and staging of patients with MASLD using routinely available clinical information
(Public library science; Public Library of Science (PLoS), 2024-02-29) McTeer, Matthew; Applegate, Douglas; Mesenbrink, Peter; Ratziu, Vlad; Schattenberg, Jörn M; Bugianesi, Elisabetta; Romero Gómez, Manuel; Missier, Paolo; Medicina; Programa de investigación e innovación Horizonte 2020 de la Unión Europea; Proyecto LITMUS - Iniciativa de Medicamentos Innovadores 2 Empresa Común; Centro de Investigación Biomédica NIHR de Newcastle; Universidad de Newcastle; Red Hat Reino Unido
Aims: Metabolic dysfunction Associated Steatotic Liver Disease (MASLD) outcomes such as MASH (metabolic dysfunction associated steatohepatitis), fibrosis and cirrhosis are ordinarily determined by resource-intensive and invasive biopsies. We aim to show that routine clinical tests offer sufficient information to predict these endpoints. Methods: Using the LITMUS Metacohort derived from the European NAFLD Registry, the largest MASLD dataset in Europe, we create three combinations of features which vary in degree of procurement including a 19-variable feature set that are attained through a routine clinical appointment or blood test. This data was used to train predictive models using supervised machine learning (ML) algorithm XGBoost, alongside missing imputation technique MICE and class balancing algorithm SMOTE. Shapley Additive exPlanations (SHAP) were added to determine relative importance for each clinical variable. Results: Analysing nine biopsy-derived MASLD outcomes of cohort size ranging between 5385 and 6673 subjects, we were able to predict individuals at training set AUCs ranging from 0.719-0.994, including classifying individuals who are At-Risk MASH at an AUC = 0.899. Using two further feature combinations of 26-variables and 35-variables, which included composite scores known to be good indicators for MASLD endpoints and advanced specialist tests, we found predictive performance did not sufficiently improve. We are also able to present local and global explanations for each ML model, offering clinicians interpretability without the expense of worsening predictive performance. Conclusions: This study developed a series of ML models of accuracy ranging from 71.9-99.4% using only easily extractable and readily available information in predicting MASLD outcomes which are usually determined through highly invasive means.
A multisociety Delphi consensus statement on new fatty liver disease nomenclature
(Mexican assoc hepatology; Elsevier, 2024) Rinellaa, ME; Lazarusb, JV; Ratziud, V; Francquee, SM; Sanyalg, AJ; Kanwalh, F; Romero Gómez, Manuel; Newsome, PN; NAFLD Nomenclature Consensus Grp; Medicina
The principal limitations of the terms NAFLD and NASH are the reliance on exclusionary confounder terms and the use of potentially stigmatising language. This study set out to determine if content experts and patient advocates were in favor of a change in nomenclature and/or definition. A modified Delphi process was led by three large pan-national liver associations. The consensus was defined a priori as a supermajority (67%) vote. An independent committee of experts external to the nomenclature process made the final recommendation on the acronym and its diagnostic criteria. A total of 236 panelists from 56 countries participated in 4 online surveys and 2 hybrid meetings. Response rates across the 4 survey rounds were 87%, 83%, 83%, and 78%, respectively. Seventy-four percent of respondents felt that the current nomenclature was sufficiently flawed to consider a name change. The terms "nonalcoholic" and "fatty" were felt to be stigmatising by 61% and 66% of respondents, respectively. Steatotic liver disease was chosen as an overarching term to encompass the various aetiologies of steatosis. The term steatohepatitis was felt to be an important pathophysiological concept that should be retained. The name chosen to replace NAFLD was metabolic dysfunction-associated steatotic liver disease. There was consensus to change the definition to include the presence of at least 1 of 5 cardiometabolic risk factors. Those with no metabolic parameters and no known cause were deemed to have cryptogenic steatotic liver disease. A new category, outside pure metabolic dysfunction-associated steatotic liver disease, termed metabolic and alcohol related/associated liver disease (MetALD), was selected to describe those with metabolic dysfunction-associated steatotic liver disease, who consume greater amounts of alcohol per week (140-350 g/wk and 210-420 g/wk for females and males, respectively). The new nomenclature and diagnostic criteria are widely supported and nonstigmatising, and can improve awareness and patient identification.
A genome-wide association study for survival from a multi-centre European study identified variants associated with COVID-19 risk of death
(Nature publishing group; nature portfolio; Springer Science and Business Media LLC, 2024-02-06) Minnai, Francesca; Biscarini, Filippo; Esposito, Martina; Dragani, Tommaso A.; Bujanda, Luis; Rahmouni, Souad; Romero Gómez, Manuel; Colombo, Francesca; Medicina; Istituto Buddista Italiano Soka Gakkai
The clinical manifestations of SARS-CoV-2 infection vary widely among patients, from asymptomatic to life-threatening. Host genetics is one of the factors that contributes to this variability as previously reported by the COVID-19 Host Genetics Initiative (HGI), which identified sixteen loci associated with COVID-19 severity. Herein, we investigated the genetic determinants of COVID-19 mortality, by performing a case-only genome-wide survival analysis, 60 days after infection, of 3904 COVID-19 patients from the GEN-COVID and other European series (EGAS00001005304 study of the COVID-19 HGI). Using imputed genotype data, we carried out a survival analysis using the Cox model adjusted for age, age2, sex, series, time of infection, and the first ten principal components. We observed a genome-wide significant (P-value < 5.0 × 10-8) association of the rs117011822 variant, on chromosome 11, of rs7208524 on chromosome 17, approaching the genome-wide threshold (P-value = 5.19 × 10-8). A total of 113 variants were associated with survival at P-value < 1.0 × 10-5 and most of them regulated the expression of genes involved in immune response (e.g., CD300 and KLR genes), or in lung repair and function (e.g., FGF19 and CDH13). Overall, our results suggest that germline variants may modulate COVID-19 risk of death, possibly through the regulation of gene expression in immune response and lung function pathways.
Energy metabolism: An emerging therapeutic frontier in liver fibrosis
(Mexican assoc hepatology, 2025) Irshad, Iram; AlQahtani, Saleh A.; Ikejima, Kenichi; Yu, Ming Lung; Romero Gómez, Manuel; Eslam, Mohammed; Medicina
Liver fibrosis is a progressive response to chronic liver diseases characterized by a wound-healing process that leads to the accumulation of fibrillary extracellular matrix (ECM) proteins in and around the liver tissue. If left untreated, liver fibrosis can advance to cirrhosis and ultimately result in liver failure. Although there have been significant advancements in understanding the molecular mechanisms involved in liver fibrosis, effective therapeutic strategies to reverse or halt the condition remain limited. Recent research has underscored the critical role of energy metabolism in the initiation and progression of liver fibrosis. In response to liver injury, hepatic cells undergo metabolic reprogramming to meet the energy demands of myofibroblasts. This reprogramming involves various metabolic changes, including mitochondrial dysfunction, alterations in cellular bioenergetics, shifts in glycolysis and oxidative phosphorylation, as well as changes in lipid metabolism. These modifications can disrupt cellular energy homeostasis and increase energy release, activating hepatic cells, primarily hepatic stellate cells (HSCs). Activated HSCs then stimulate fibrogenic pathways, leading to the accumulation of ECM proteins in the liver, which exacerbates the progression of fibrosis. This review aims to explore the emerging connection between energy metabolism and liver fibrosis, focusing on the metabolic alterations and molecular mechanisms that drive this condition. We also examine the therapeutic implications of modulating energy metabolism to reduce energy release and mitigate liver fibrosis. Altering energy metabolism to decrease energy release may represent a promising approach for treating liver fibrosis and chronic liver diseases.
Steroid therapy is linked to lower incidence of acute kidney injury in patients with severe alcohol-associated hepatitis
(Nature publishing group; Nature portfolio; Springer Science and Business Media LLC, 2025-12-08) Buttler, Laura; Stange, Jan; Pyrsopoulos, Nikolaos; Hassanein, Tarek; Wedemeyer, Heiner; Maasoumy, Benjamin; Romero Gómez, Manuel; Reich, David; Medicina
Acute kidney injury (AKI) is a common complication in patients with severe alcohol-associated hepatitis (sAH), yet its risk factors and outcomes remain incompletely defined. Corticosteroids are the only established therapy for sAH, but their impact on renal outcomes is unknown. A post-hoc analysis of the prospective multicenter VTL-308 trial including 151 patients with sAH was conducted to evaluate the incidence and predictors of AKI, the association of corticosteroid therapy with AKI risk, and factors associated with AKI reversal during 90 days of follow-up. AKI was independently associated with significantly higher 90-day mortality (subdistribution hazard ratio (sHR) = 8.74; p < 0.001). In multivariate competing risk analysis, higher bilirubin levels (sHR = 1.06; p = 0.003) were linked to increased AKI risk, while corticosteroids were associated with an ameliorated AKI risk (sHR = 0.47; p = 0.01). Time-censored analyses confirmed the protective association of corticosteroids (HR = 0.25; p = 0.001). Once AKI occurred, corticosteroids did not promote renal recovery (HR = 1.15; p = 0.74). Elevated bilirubin levels were linked to a lower probability of AKI reversal. In conclusion, AKI is a devastating complication in sAH. Corticosteroid therapy is independently associated with a significantly lower risk of AKI development but does not influence recovery once AKI has occurred. Future prospective trials are required to provide further validation of these findings.
New molecules for treating metabolic-associated dysfunction steatotic liver disease (MASLD)
(Mexican assoc hepatology; Elsevier, 2025) Romero Gómez, Manuel; Medicina
Global research initiative for patient screening on MASH (GRIPonMASH) protocol: Rationale and design of a prospective multicentre study
(BMJ Publishing group, 2025) De Jong, Vivian D.; Alings, Marco; Bruha, Radan; Cortez-Pinto, Helena; Dedoussis, George V.; Doukas, Michail; Romero Gómez, Manuel; Castro Cabezas, Manuel; Medicina; Unión Europea; Empresa Común de la Iniciativa de Salud Innovadora (IHI JU); Tecnología Médica Europa
Introduction The prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) may be as high as 38% in the adult population with potential serious complications, multiple comorbidities and a high socioeconomic burden. However, there is a general lack of awareness and knowledge about MASLD and its progressive stages (metabolic dysfunction-associated steatohepatitis (MASH) and fibrosis). Therefore, MASLD is still far underdiagnosed. The ‘Global Research Initiative for Patient Screening on MASH’ (GRIPonMASH) consortium focuses on this unmet public health need. GRIPonMASH will help (primary) healthcare providers to implement a patient care pathway, as recommended by multiple scientific societies, to identify patients at risk of severe MASLD and to raise awareness. Furthermore, GRIPonMASH will contribute to a better understanding of the pathophysiology of MASLD and improved identification of diagnostic and prognostic markers to detect individuals at risk. Methods This is a prospective multicentre observational study in which 10 000 high-risk patients (type 2 diabetes mellitus, obesity, metabolic syndrome or hypertension) will be screened in 10 European countries using at least two non-invasive tests (Fibrosis-4 index and FibroScan). Blood samples and liver biopsy material will be collected and biobanked, and multiomics analyses will be conducted. Ethics and dissemination The study will be conducted in compliance with this protocol and applicable national and international regulatory requirements. The study initiation package is submitted at the local level. The study protocol has been approved by local medical ethical committees in all 10 participating countries. Results will be made public and published in scientific, peer-reviewed, international journals and at international conferences.
ColorPhAST: a visual rapid colorimetric assay for detecting phage-susceptibility in Escherichia coli
(Frontiers Media S.A., 2025-07-11) Gómez Estévez, Paula; Rodríguez Villodres, Ángel; Gálvez Benítez, Lydia; Martín Gutiérrez, Guillermo; Cisneros, José Miguel; Rosa Utrera, José Manuel de la; Lepe Jiménez, José Antonio; Genética; Medicina; Electrónica y Electromagnetismo; Instituto de Salud Carlos III; Ministerio de Ciencia, Innovación y Universidades (MICIU). España
The alarming increase in the prevalence of multidrug-resistant microorganisms, which in some cases has left no available treatment options, has led to a renewed interest in previously abandoned therapeutic approaches such as bacteriophage therapy. Therefore, the development of rapid methods for determining phage susceptibility will be essential in the near future because phage-based treatments could provide a viable alternative for patients with infections caused by multidrugresistant microorganisms. In response to this need, a new test named ColorPhAST (Color Phage Activity Susceptibility Test) based on color change of red phenol has been designed to detect phage-susceptibility in just 2 h. A total of 100 Escherichia coli isolates were used to evaluate the performance of the test, 55 being resistant to the isolated phage through the double agar overlay spot assay (gold standard method). The sensitivity and specificity of the test were 95.6 and 100%, respectively. The ColorPhAST is a fast, easy-to-performed, and accurate method with great potential for identifying susceptibility to bacteriophages.
A Selective Chromogenic Medium for Detecting Meropenem-Resistant Pseudomonas aeruginosa in Respiratory Samples
(MDPI, 2025-05-09) Cintora Mairal, Carmen; Martín Gutiérrez, Guillermo; Rodríguez Villodres, Ángel; Cisneros, José Miguel; Lepe Jiménez, José Antonio; Rosa Utrera, José Manuel de la; Microbiología; Medicina; Electrónica y Electromagnetismo; Instituto de Salud Carlos III; Ministerio de Ciencia, Innovación y Universidades (MICIU). España
Background/Objectives: Meropenem is widely used to treat Pseudomonas aeruginosa infections; however, the pathogen’s increasing resistance compromises its efficacy. In this study, we aimed to develop a selective culture medium for detecting the presence of meropenem-resistant Pseudomonas aeruginosa in respiratory specimens within 24 h. Methods: The medium’s performance was challenged using a collection of 130 clinical Pseudomonas aeruginosa strains (of which 85 were meropenem-susceptible, 14 were meropenemintermediate, and 21 were meropenem resistant). Subsequently, clinical validation was carried out using 130 respiratory samples. Results: The selective medium demonstrated excellent sensitivity (average 98.7%) and specificity (average 90%) across bacterial concentrations ranging from 1 × 104 to 1 × 108 CFU/mL, and a high negative predictive value (average 99.2%) compared to the broth microdilution (BMD) method. Clinical validation with bronchoalveolar lavage (BAL) and tracheobronchial aspirate (TBA) clinical specimens (N = 130) revealed a strong performance, with 92,3% categorical agreement. Conclusions: This method accelerates susceptibility testing, is user-friendly, and delivers reliable results, contributing to the optimization of empirical treatment for respiratory tract infections.
Halting hepatocellular carcinoma: Identifying intercellular crosstalk in HBV-driven disease
(Cell Press, Elsevier BV, 2025-04-22) Zhou, Lingyun; Liu, Chang Hai; Lv, Duoduo; Sample, Klarke Michael; Rojas, Ángela; Zhang, Yugu; Romero Gómez, Manuel; Medicina; Plataforma Integral de Investigación para la Prevención y Control del SIDA del Hospital del Oeste de China, Universidad de Sichuan; Proyecto GRIPonMASH de la Iniciativa Innovar en Salud; Instituto de Salud Carlos III; Fundación Nacional de Ciencias Naturales de China; Proyecto de Apoyos Científicos y Tecnológicos de la Provincia de Sichuan
Hepatitis B infection can lead to liver fibrosis and hepatocellular carcinoma (HCC). Despite antiviral therapies, some patients still develop HCC. This study investigates hepatitis B virus (HBV)-induced hepatocyte-hepatic stellate cell (HSC) crosstalk and its role in liver fibrosis and HCC. Using MYC-driven liver cancer stem cell organoids, HCC-patient-derived xenograft (PDX) models, and HBV replication models, this study reveals that HBV transcription affected hepatocyte development, activated the DNA repair pathway, and promoted glycolysis. HBV activated nicotinamide phosphoribosyltransferase (NAMPT) through DNA damage receptor ATR. NAMPT-insulin receptor (INSR)-mediated hepatocyte-HSC crosstalk caused HSCs to develop a myofibroblast phenotype and activated telomere maintenance mechanisms via PARP1 multisite lactylation. Inhibition of the ATR-NAMPT-INSR-PARP1 pathway effectively blocks HBV-induced liver fibrosis and HCC progression. Targeting this pathway could be a promising strategy for chronic HBV infection management.
Comparison of diagnostic performance of GAAD, GALAD, and ASAP scores for detecting hepatocellular carcinoma in advanced liver fibrosis patients
(De Gruyter, 2026-01-15) Izquierdo-Martínez, Alberto; Rojas, Ángela; Rubio-Sánchez, Ricardo; Dominguez-Pascual, Inmaculada; Romero Gómez, Manuel; Medicina
Objectives Alpha-fetoprotein L3 (AFP-L3 %) and protein induced by vitamin K absence-II (PIVKA-II) are used in diagnostic scores such as GAAD, GALAD, and ASAP for hepatocellular carcinoma (HCC) detection. Advanced liver fibrosis (ALF) is diagnosable by the liver fibrosis index and could be combined with these blood biomarkers for better HCC detection. Methods This study developed an analytical framework to address the role of GAAD, GALAD, and ASAP in ALF patients as a risk score to predict HCC. By analyzing data from 21 HCC and 30 ALF patients, this analysis assessed the diagnostic accuracy of individual biomarkers, ASAP, GAAD, and GALAD. Results GAAD slightly outperformed AFP (sensitivity: 76.2 %, specificity: 88.5 %). The combination of AFP and PIVKA-II also surpassed AFP alone. PIVKA-II and AFP-L3 showed the worst performance for identifying HCC. Conclusions GAAD and ASAP showed comparable or slightly superior performance to AFP, suggesting potential for screening strategies that should be confirmed in larger studies.
Neuroblastoma RAS viral oncogene homolog (N-RAS) deficiency aggravates liver injury and fibrosis
(Springer Nature, 2023-08-10) Zheng, Kang; Hao, Fengjie; Medrano García, Sandra; Chen, Chaobo; Guo, Feifei; Gallego Durán, Rocío; Maya Miles, Douglas; Ampuero Herrojo, Javier; Romero Gómez, Manuel; Cubero, Francisco Javier; Fisiología; Medicina; Ministerio de Ciencia e Innovación (MICIN). España; European Union (UE); Comunidad Autónoma de Madrid
Progressive hepatic damage and fibrosis are major features of chronic liver diseases of different etiology, yet the underlying molecular mechanisms remain to be fully defined. N-RAS, a member of the RAS family of small guanine nucleotide-binding proteins also encompassing the highly homologous H-RAS and K-RAS isoforms, was previously reported to modulate cell death and renal fibrosis; however, its role in liver damage and fibrogenesis remains unknown. Here, we approached this question by using N-RAS deficient (N-RAS−/−) mice and two experimental models of liver injury and fibrosis, namely carbon tetrachloride (CCl4) intoxication and bile duct ligation (BDL). In wild-type (N-RAS+/+) mice both hepatotoxic procedures augmented N-RAS expression in the liver. Compared to N-RAS+/+ counterparts, N-RAS−/− mice subjected to either CCl4 or BDL showed exacerbated liver injury and fibrosis, which was associated with enhanced hepatic stellate cell (HSC) activation and leukocyte infiltration in the damaged liver. At the molecular level, after CCl4 or BDL, N-RAS−/− livers exhibited augmented expression of necroptotic death markers along with JNK1/2 hyperactivation. In line with this, N-RAS ablation in a human hepatocytic cell line resulted in enhanced activation of JNK and necroptosis mediators in response to cell death stimuli. Of note, loss of hepatic N-RAS expression was characteristic of chronic liver disease patients with fibrosis. Collectively, our study unveils a novel role for N-RAS as a negative controller of the progression of liver injury and fibrogenesis, by critically downregulating signaling pathways leading to hepatocyte necroptosis. Furthermore, it suggests that N-RAS may be of potential clinical value as prognostic biomarker of progressive fibrotic liver damage, or as a novel therapeutic target for the treatment of chronic liver disease.
Fungal microbiota dynamics and its geographic, age and gender variability in patients with cystic fibrosis
(Elsevier, 2022-11-09) Martínez Rodríguez, Sara; Friaza, Vicente; Girón Moreno, Rosa M.; Quintana Gallego, Esther; Salcedo Posadas, Antonio; Figuerola Mulet, Joan; Solé Jover, Amparo; Campano, Elena; Morilla Romero de la Osa, Rubén; Calderón Sandubete, Enrique José; Medrano Ortega, Francisco Javier; Horra Padilla, Carmen de la; Medicina; Enfermería; Junta de Andalucía; Gobierno de España
Objectives: In cystic fibrosis (CF), there is a predisposition to bronchial colonization by potentially pathogenic microorganisms, such as fungi. Our aims were to describe the dynamics of respiratory mycobiota in patients with CF and to evaluate the geographic, age and gender variability in its distribution. Methods: Cohort study in which 45 patients with CF from four hospitals in three Spanish cities were followed up during a 1-year period, obtaining spontaneous sputum samples every 3 to 6 months. Fungal microbiota were characterized by Internal Transcribed Spacer sequencing and Pneumocystis jirovecii was identified by nested PCR in a total of 180 samples. Results: The presence of fungi were detected in 119 (66.11%) of the 180 samples and in 44 (97.8%) of the 45 patients: 19 were positive and 1 negative throughout all follow-ups and the remaining 25 presented alternation between positive and negative results. A total of 16 different genera were identified, with Candida spp. (50/180, 27.78%) and Pneumocystis spp. (44/180, 24.44%) being the most prevalent ones. The distribution of fungal genera was different among the evaluated centres (p < 0.05), by age (non-adults aged 6–17 years vs. adults aged ≥18 years) (p < 0.05) and by gender (p < 0.05). Discussion: A high prevalence of fungal respiratory microbiota in patients with CF was observed, whose dynamics are characterized by the existence of multiple cycles of clearance and colonization, reporting the existence of geographic, age and gender variability in the distribution of fungal genera in this disease.
Acute heart failure – an EFIM guideline critical appraisal and adaptation for internists
(Elsevier, 2024-05) Kokorin, Valentin A.; González-Franco, Alvaro; Cittadini, Antonio; Kalejs, Oskars; Larina, Vera N.; Marra, Alberto M.; Medrano Ortega, Francisco Javier; Lesniak, Wiktoria; Medicina
Background: Over the past two decades, several studies have been conducted that have tried to answer questions on management of patients with acute heart failure (AHF) in terms of diagnosis and treatment. Updated international clinical practice guidelines (CPGs) have endorsed the findings of these studies. The aim of this document was to adapt recommendations of existing guidelines to help internists make decisions about specific and complex scenarios related to AHF. Methods: The adaptation procedure was to identify firstly unresolved clinical problems in patients with AHF in accordance with the PICO (Population, Intervention, Comparison and Outcomes) process, then conduct a critical assessment of existing CPGs and choose recommendations that are most applicable to these specific scenarios. Results: Seven PICOs were identified and CPGs were assessed. There is no single test that can help clinicians in discriminating patients with acute dyspnoea, congestion or hypoxaemia. Performing of echocardiography and natriuretic peptide evaluation is recommended, and chest X-ray and lung ultrasound may be considered. Treatment strategies to manage arterial hypotension and low cardiac output include short-term continuous intravenous inotropic support, vasopressors, renal replacement therapy, and temporary mechanical circulatory support. The most updated recommendations on how to treat specific patients with AHF and certain comorbidities and for reducing post-discharge rehospitalization and mortality are provided. Overall, 51 recommendations were endorsed and the rationale for the selection is provided in the main text. Conclusion: Through the use of appropriate tailoring process methodology, this document provides a simple and updated guide for internists dealing with AHF patients.
New insights into IL-6 family cytokines in metabolism, hepatology and gastroenterology
(Springer Nature, 2021-11) Giráldez, María D.; Carneros, David; Garbers, Christoph; Rose-John, Stefan; Bustos, Matilde; Instituto de Biomedicina de Sevilla (IBIS); Predoctoral iPFIS; Instituto de Salud Carlos III; Juan Rodes contract; European Commission. Fondo Social Europeo (FSO); European Commission (EC). Fondo Europeo de Desarrollo Regional (FEDER); Junta de Andalucía; Deutsche Forschungsgemeinschaft / German Research Foundation (DFG)
IL-6 family cytokines are defined by the common use of the signal-transducing receptor chain glycoprotein 130 (gp130). Increasing evidence indicates that these cytokines are essential in the regulation of metabolic homeostasis as well as in the pathophysiology of multiple gastrointestinal and liver disorders, thus making them attractive therapeutic targets. Over the past few years, therapies modulating gp130 signalling have grown exponentially in several clinical settings including obesity, cancer and inflammatory bowel disease. A newly engineered gp130 cytokine, IC7Fc, has shown promising preclinical results for the treatment of type 2 diabetes, obesity and liver steatosis. Moreover, drugs that modulate gp130 signalling have shown promise in refractory inflammatory bowel disease in clinical trials. A deeper understanding of the main roles of the IL-6 family of cytokines during homeostatic and pathological conditions, their signalling pathways, sources of production and target cells will be crucial to the development of improved treatments. Here, we review the current state of the role of these cytokines in hepatology and gastroenterology and discuss the progress achieved in translating therapeutics targeting gp130 signalling into clinical practice.
Pulmonary pneumocystosis in a captive kinkajou with molecular evidence of a novel Pneumocystis lineage
(SAGE Publications, 2026-01) Díaz-Santana, Pablo; Suárez-Bonnet, Alejandro; Déniz-Marrero, Javier; Salguero, Francisco J.; Martí-Garcia, Bernat; Friaza, Vincente; Calderón Sandubete, Enrique José; Fingerhood, Sai; Medicina
An 11-mo-old, intact male captive kinkajou (Potos flavus) was submitted for postmortem investigation because of emaciation and hindlimb overgrooming. Histologically, alveolar airspaces were filled with fungal structures that were morphologically and histochemically consistent with Pneumocystis spp. PCR of pulmonary tissue was negative for canine distemper virus and positive for Pneumocystis spp. Molecular testing yielded amplification of the Pneumocystis spp. mitochondrial large-subunit rRNA (mtLSU rRNA, 510 bp) and the small-subunit rRNA (mtSSU rRNA, 565 bp). Phylogenetic analysis suggested a potentially novel Pneumocystis lineage associated with P. flavus. Additional nuclear loci are required to confirm its taxonomic status. Gastric and colonic histologic findings included concurrent candidiasis and colonic nematodosis. An underlying immunosuppressive disease was suspected. Further investigation is required to clarify the role of kinkajous in the ecology of fungal pathogens and the causes of immunosuppression in this species, particularly in the context of human-wildlife interactions. Enhanced surveillance and interdisciplinary collaboration are essential to evaluate potential zoonotic risks and inform conservation and public health strategies.
Tralokinumab effectiveness in moderate-to-severe atopic dermatitis with palmoplantar eczema
(Elsevier, 2026-01) Domínguez-Cruz, J.J.; Navarro-Triviño, F.J.; Galán-Gutiérrez, M.; Pereyra-Rodríguez, José-Juan; Armario-Hita, J.C.; Ruiz-Villaverde, R.; Medicina
Hospitalizations due to hidradenitis suppurativa in Spain between 2016 and 2021: demographic and stratified analysis by sex for a population cohort
(Elsevier, 2026-03) Ortiz-Álvarez, J.; Pereyra-Rodríguez, José-Juan; Conejo-Mir Sánchez, Julián; Osorio Gómez, G.; Medicina
Efectividad y seguridad del baricitinib en la dermatitis atópica en la práctica clínica: estudio retrospectivo multicéntrico de cuatro hospitales andaluces (España)
(Elsevier, 2024) Navarro-Triviño, Francisco José; Galán Gutiérrez, Manuel; Pereyra-Rodríguez, José-Juan; Ruiz Villaverde, Ricardo; Medicina

Examinar

Envíos recientes